Provider Demographics
NPI:1881759595
Name:KUPRIANOWICZ, CEZARY (MD)
Entity type:Individual
Prefix:
First Name:CEZARY
Middle Name:
Last Name:KUPRIANOWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 W 11TH PL
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-4114
Mailing Address - Country:US
Mailing Address - Phone:432-264-1300
Mailing Address - Fax:432-264-7381
Practice Address - Street 1:1605 W 11TH PL
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4114
Practice Address - Country:US
Practice Address - Phone:432-264-1300
Practice Address - Fax:432-264-7381
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4117207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A9851OtherBCBS PROVIDER NUMBER
TX117203101OtherFIRSTCARE PROVIDER NUMBER
TX290010000OtherRAILROAD MEDICARE PROV NO
TX113316702Medicaid
TX0014CBMedicare ID - Type Unspecified
TX113316702Medicaid